Definition/General
Introduction:
BPH is benign enlargement of the prostate gland
Results from epithelial and stromal hyperplasia
Affects transition zone primarily
Age-related condition
Most common urologic condition in men.
Origin:
Arises from transition zone of prostate
Involves stromal and epithelial hyperplasia
Hormonal influences (DHT, estrogen)
Growth factors and inflammation
Age-related changes.
Classification:
Microscopic patterns: Stromal hyperplasia
Glandular hyperplasia
Mixed type (most common)
Stromal predominant
Glandular predominant
Clinical: LUTS severity.
Epidemiology:
Age-related: 50% by age 50
90% by age 90
Universal in aging men
Symptomatic in 50%
Racial variations
Genetic predisposition.
Clinical Features
Presentation:
Lower urinary tract symptoms (LUTS)
Obstructive symptoms: hesitancy, weak stream
Irritative symptoms: frequency, urgency
Nocturia
Incomplete emptying.
Symptoms:
Urinary frequency
Urgency
Nocturia
Weak urinary stream
Hesitancy
Intermittency
Incomplete bladder emptying
Urinary retention.
Risk Factors:
Advancing age
Family history
Hormonal factors (testosterone, DHT)
Metabolic syndrome
Obesity
Diabetes
Physical inactivity.
Screening:
Digital rectal examination
PSA levels
Urinalysis
Uroflowmetry
Post-void residual
IPSS questionnaire
Transrectal ultrasound.
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Gross Description
Appearance:
Enlarged prostate (>30-40 grams)
Smooth, rubbery consistency
Well-demarcated nodules
Tan-gray color
Cystic spaces
Transition zone enlargement.
Characteristics:
Multinodular appearance
Firm consistency
Homogeneous cut surface
Cystic dilatation
Smooth nodular surface
Well-circumscribed.
Size Location:
Transition zone primarily affected
Periurethral region
Variable size (30-200+ grams)
Bilateral enlargement
May compress urethra
Median lobe involvement.
Multifocality:
Multifocal nodules
Bilateral process
Variable distribution
Asymmetric growth
Progressive enlargement
May involve all zones.
Microscopic Description
Histological Features:
Stromal hyperplasia: Smooth muscle and fibrous tissue
Glandular hyperplasia: Increased gland number
Mixed pattern most common
Papillary infoldings
Basal cell layer preserved.
Cellular Characteristics:
Benign epithelial cells
Preserved basal cell layer
Columnar to cuboidal epithelium
Smooth muscle hyperplasia
Inflammatory infiltrate
No cellular atypia.
Architectural Patterns:
Nodular hyperplasia
Cystic gland dilatation
Papillary projections
Crowded glands
Stromal proliferation
Corpora amylacea.
Grading Criteria:
No grading system
Assessment: Stromal vs glandular predominance
Degree of hyperplasia
Inflammatory component
Cystic change.
Immunohistochemistry
Positive Markers:
34βE12 - positive (basal cells)
p63 - positive (basal cells)
PSA - positive (luminal cells)
PSAP - positive
Smooth muscle actin - positive (stroma)
Cytokeratin 8/18 - positive.
Negative Markers:
AMACR - negative (vs cancer)
Chromogranin A - negative
Synaptophysin - negative
High molecular weight cytokeratin - negative (luminal).
Diagnostic Utility:
Basal cell markers (34βE12, p63) confirm benign nature
AMACR negative helps exclude cancer
PSA positive confirms prostatic origin
SMA highlights stromal component.
Molecular Subtypes:
Stromal predominant: High SMA expression
Glandular predominant: More PSA expression
Mixed type: Balanced markers
All types: Intact basal cell layer.
Molecular/Genetic
Genetic Mutations:
No specific mutations
Hormonal influences
Growth factor dysregulation
Androgen receptor sensitivity
IGF-1 pathway
FGF signaling.
Molecular Markers:
5α-reductase activity
DHT accumulation
Estrogen receptors
Growth factors (FGF, IGF)
Inflammatory mediators
Apoptosis resistance.
Prognostic Significance:
Benign condition
No malignant potential
Progressive enlargement
Symptom severity variable
Quality of life impact
Complications possible.
Therapeutic Targets:
5α-reductase inhibitors (finasteride, dutasteride)
α1-blockers (tamsulosin)
PDE5 inhibitors
β3-agonists
Combination therapy
Surgical options (TURP, laser).
Differential Diagnosis
Similar Entities:
Prostatic adenocarcinoma
Prostatic intraepithelial neoplasia
Atypical adenomatous hyperplasia
Prostatic atrophy
Granulomatous prostatitis.
Distinguishing Features:
BPH: Basal cells present, AMACR-, no atypia
Adenocarcinoma: Basal cells absent, AMACR+, cytologic atypia
PIN: Basal cells present, nuclear atypia
AAH: Atypical features, crowded glands.
Diagnostic Challenges:
Atypical hyperplasia
Crowded glands
Crush artifact
Limited tissue
Inflammation masking features
Transition zone sampling.
Rare Variants:
Atypical adenomatous hyperplasia
Basal cell hyperplasia
Cribriform hyperplasia
Postatrophic hyperplasia.
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[TURP/Biopsy] specimen consisting of [amount] of tissue
Gross Description
[Amount] grams of tan-gray prostatic tissue chips
Microscopic Findings
Benign prostatic tissue showing [stromal/glandular/mixed] hyperplasia with preserved basal cell layer
Hyperplasia Pattern
[Stromal predominant/Glandular predominant/Mixed pattern]
Immunohistochemistry
34βE12: Positive (basal cells), PSA: Positive (luminal cells), AMACR: Negative
Final Diagnosis
Benign prostatic hyperplasia with [stromal/glandular/mixed] pattern
Comments
No evidence of malignancy identified. Correlation with clinical symptoms recommended.